Vol. 22, No. 5,514 - The American Reporter - September 7, 2016

by Harvey Widroe, M.D.
American Reporter Correspondent
Orinda, Calif.
September 26, 2007
Shrink's Progress

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ORINDA, Calif. -- She wondered if she drank too much. She acknowledged that a bottle of wine every night just might be the start of a problem. Was it because of loneliness?

Margie at 30 couldn't tell if feeling unhappy had led to her drinking more, or whether drinking more had made her more depressed. She concluded that it was probably both. Her current boyfriend, who wasn't a "keeper" anyway, had complained that she was more irritable and inappropriate after she had had a few drinks. At work Margie resented her most recent annual review. It described an increased error rate, decreased overall productivity, and grumpiness with her co-workers. She felt picked on without cause, and considered polishing her resume, perhaps to seek another job where her talents would be appreciated.

Her drinking wasn't even close to the non-stop, half-inebriated life of her parents. Nonetheless, it might be just a little too much. Admittedly there were too many evenings after which she couldn't remember the next morning. What might have happened had she decided to drive some place? But the blackouts didn't scare her as much as the painful bruises, undeniable indicators that she'd fallen or bumped into her furniture while drunk.

She had lied to her primary care doctor about the amount she actually drank, but he didn't seem to believe her. He advised her to cut way back. Her liver enzyme levels, he told her, were only slightly abnormal for now. He explained, however, that nature gave us six times as much liver tissue as we needed in order to survive; that we could damage a lot of liver tissue by drinking before the blood tests showed very much. And once the final sixth of liver was in trouble, we could go down hill fast; with little prospect of rescue. All Margie heard the doctor say was that she probably drank a little too much, but that she didn't really have an alcohol problem.

Her alcoholic parents disagreed, and they knew from experience what they were talking about. They nagged her into going to an Alcoholics Anonymous meeting, but she quickly concluded that she wasn't at all like the rest of the faithful AA congregation. She came up with half a dozen reasons why she was different. Many of the AA members had "bottomed out," had lost jobs, spouses -- even kids. She wasn't nearly that bad. And she didn't like the idea that she was helpless and needed to give herself into the hands of a "higher power." It all sounded too cult-like to her.

Besides, Margie didn't want to stop drinking. Why should she have to accept the idea of total abstinence when a glass or two tasted so good and made the evenings so much more comfortable. She looked forward to a few drinks after work. Perhaps if she could just ration it out, set a two glass limit, there wouldn't be a problem. The plan worked for a few days, but there were always excuses that led to her going over the limit. A special celebration, or extra work stress, or an especially good wine, all added up to her drinking too much. She finally junked the two glass limit.

A warning about her increasing late arrivals to work finally brought Margie back to her doctor. This time she told the straight story, revealing how much she actually drank. Even before he could mention it, she warned him that AA was not for her, that she wasn't a "serious alcoholic."

When he began talking about Antabuse, she almost exploded. He was proposing to give her a medication which, if she decided to have even a taste of wine, would make her seriously ill. And if she drank a whole lot on top of her Antabuse, she was told, she would be sick with nausea, vomiting, diarrhea, pounding heart, sweating, and feel pain all over. She would wish she were dead, even if the Antabuse- alcohol reaction didn't actually kill her. "Forget that idea!" she said.

Her doctor mentioned another medication, Flagyl, a kind of lighter version of Antabuse. But that didn't appeal to her, either, and she rejected his proposal. Her mind closed off to any other thought of chemicals intended for people with far more serious alcohol problems than hers. She announced that she was willing to settle for a mild antidepressant, as long as it didn't make her gain weight.

Is Margie an alcoholic? Of course she is! She drinks way too much. She drinks almost daily. She looks forward to drinking much of the time. Her social life and performance at work are adversely affected by her drinking. She has blackouts after drinking too much, and she suffers injuries while drunk.

Margie uses certain mental mechanisms seen very commonly in alcoholics. She denies facts that are obvious to everyone around her. It is as though she can't recognize simple reality regarding her drinking and the effect it is having on her life. She projects responsibility for her own behavior onto others. It is her boyfriend who is too demanding. It is her parents who, because of their own alcohol problems, all too readily tend to see it in others. At work, despite her performance decline, she isn't appreciated. She rationalizes her behavior and her drinking so that there is always an excuse for drinking -- every single day. There's always a holiday, a celebration, work stress or some personal problems that call for a few drinks. It usually takes something dramatic to get an alcoholic like Margie to realize that he or she has a drinking-related problem.

And all alcoholics who first attend an AA meeting don't see themselves as belonging there. Like Claire, they all see themselves as totally different from the other alcoholics. I always have to urge my patients to go back and take another look; even if they are "different" from all of the others. Fortunately AA members are quick to spot and to extend a friendly hand to anyone who attends for the first time or who just looks isolated and detached.

With whatever tools or techniques we shrinks may have for helping alcoholics (and we do have a few which I will describe in another article), no psychotherapy or medication is as powerful or effective as AA. Our work as therapists or physicians is to supplement the supportive atmosphere and techniques that AA can provide.

Harvey Widroe, a longtime practicing psychiatrist, is the author of the recently published, "Eat and Watch Pounds Melt Away," with Ron Kenner (Outskirts Press)

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